Cancer survivors’ experience with depressive symptoms and their (low) need for psychological care:Lessons learned from a multi-center randomized controlled trial

This thesis focused on cancer survivors that have finished curative treatment at least one year ago and experience depressive symptoms. Key findings were: 1) low levels of depressive symptoms in this group, suggesting that most cancer survivors are able to regain a sense of psychological wellbeing; 2) of those with elevated depressive symptoms, many did not want help for their symptoms. More research is needed to better understand how cancer survivors perceive and cope with depressive symptoms and reasons for (not) seeking care. Such insights are required in order to optimally guide cancer patients throughout the illness trajectory.We initially aimed to compare two psychological depression treatments (CBT vs MBCT) among cancer survivors. We approached 2,608 cancer survivors for depression screening, of whom 147 reported depressive symptoms. A large group could not participate, because they already received treatment or reported no care needs. In total, only 25 people participated in the trial. Consequently, rather than examining the efficacy, we discussed possible reasons for low care needs. We conducted additional research on mindfulness and depressive symptoms. Results showed that: (1) mindfulness was, irrespective of stress, related to lower depression levels; (2) subgroups of depressed cancer patients can be distinguished on both overall depression levels and distinct symptoms; (3) somatic depression symptoms (e.g. fatigue) should not be excluded when assessing depressive symptoms among chronic ill, as these discriminate good for mild depression; (4) cognitive-affective depression symptoms (e.g. depressed mood) better predicted patients’ care needs than somatic depression symptoms (e.g. fatigue)